Abstract
BackgroundHigh-risk surgery patients may lose decision-making capacity as a result of surgical complications. Advance care planning prior to surgery may be beneficial, but remains controversial and is hindered by a lack of appropriate decision aids. This study sought to examine stakeholders’ views on the appropriateness of using decision aids, in general, to support advance care planning among high-risk surgery populations and the design of such a decision aid.MethodsKey informants were recruited through purposive and snowball sampling. Semi-structured interviews were conducted by phone until data collected reached theoretical saturation. Key informants were asked to discuss their thoughts about advance care planning and interventions to support advance care planning, particularly for this population. Researchers took de-identified notes that were analyzed for emerging concordant, discordant, and recurrent themes using interpretative phenomenological analysis.ResultsKey informants described the importance of initiating advance care planning preoperatively, despite potential challenges present in surgical settings. In general, decision aids were viewed as an appropriate approach to support advance care planning for this population. A recipe emerged from the data that outlines tools, ingredients, and tips for success that are needed to design an advance care planning decision aid for high-risk surgical settings.ConclusionsStakeholders supported incorporating advance care planning in high-risk surgical settings and endorsed the appropriateness of using decision aids to do so. Findings will inform the next stages of developing the first advance care planning decision aid for high-risk surgery patients.
Highlights
High-risk surgery patients may lose decision-making capacity as a result of surgical complications
While high-risk surgeries performed by high volume surgeons and hospitals are associated with better patient outcomes [4,7], a subset of patients will still experience complications [3,4,5,6,7]. It would be advantageous for patients preparing for high-risk surgery to engage in advance care planning—a process by which patients make preparations for medical decision making
Decision aids are a specific type of decision support intervention and, as described by Stacey et al, they are tools grounded in scientific evidence that aim to prepare people for active, informed participation in decisions about their healthcare options [15]
Summary
High-risk surgery patients may lose decision-making capacity as a result of surgical complications. Recent studies report that since the late 1990s mortality rates have declined among patients who undergo high-risk surgery procedures in the United States, despite increases in the number of operations performed [1,2]. In spite of this improvement, there are inherent risks associated with any surgery, and complications, including death, may occur [3,4,5,6]. None have been developed or evaluated for use in a high-risk surgical setting [24,25]
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